Discussion: Controlling Medicare spending is a difficult task. Even if provider reimbursement rates are reduced, physicians and hospitals may increase volume and intensity of services to make up for lost revenue. The ACA included a number of pilot programs and demonstration projects to experiment with reforming the way health care is financed and delivered, and MACRA increased the incentives for physicians to participate in these experiments. Some of these projects include bundling payment for acute care services; using value-based purchasing, which ties payments to quality outcomes; and creating accountable care organizations that bring together providers across the healthcare spectrum and reward organizations with better outcomes. The ACA created the Centers for Medicare and Medicaid Services (CMS) Innovation Center to oversee these and other reform projects. What approach to reducing costs and improving quality do you prefer? What are the advantages and disadvantages of these ideas?